Do Patients with Elderly-Onset Rheumatoid Arthritis Have Severe Functional Disability?

Cho, Soo Kyung; Sung, Yoon Kyoung; Choi, Chan Bum; Suk, Hoon; Choe, Jung Yoon; Chung, Won Tae; Hong, Seung Jae; Jun, Jae Bum; Kim, Jinseok; Kim, So Yeon; Kim, Tae Jong; Koh, Eunmi; Lee, Hye Soon; Lee, Sang Hoon; Lee, Shin Seok; Lee, Sung Won; Yoo, Dae Hyun; Yoon, Bo Young; Bae, Sang Cheol

doi:10.1016/j.semarthrit.2012.02.004

Cited by 45 publications

(44 citation statements)

References 18 publications

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“…Our findings are comparable to other studies showing a lower female predominance and less seropositivity in LORA [3,6,8,11,12]. This contrasts previous evidence of elevated RF titers due to increasing age alone; however, seroconversion over time is possible and was not formally assessed in this study [14].…”

Section: Discussionsupporting

confidence: 84%

“…The degree of joint damage has been shown to be higher in LORA, while others report no difference in radiographic progression between YORA and LORA patients [4,[7][8][9][10]. Varied results are noted when disease severity is defined in terms of disability, as measured using the Health Assessment Questionnaire (HAQ) [3,6,7,[9][10][11][12]. Additionally, the types of therapy selected and the effect of treatment influencing these outcomes may differ according to an individual's age at the time of RA onset [5,13].…”

Section: Introductionmentioning

confidence: 99%

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The influence of age at disease onset on disease activity and disability: results from the Ontario Best Practices Research Initiative

et al. 2015

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This study aims to compare characteristics between late-onset rheumatoid arthritis (RA) and young-onset RA and determine the association between age at disease onset and disease severity. We cross-sectionally studied 971 patients at the time of entry into the Ontario Best Practices Research Initiative, a registry of RA patients followed up in routine care. We restricted patients to ≤5 years of disease duration. Late-onset RA was defined as an onset ≥60 years of age and young-onset RA <60 years. Group differences were compared, and multivariate linear regression models were used to test the influence of age at onset on Disease Activity Score in 28 Joints with erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire (HAQ) scores. The swollen joint count (6.2 vs. 5.3), acute phase reactants (C-reactive protein (CRP) 17.4 vs. 11.8 mg/L, ESR 30.6 vs. 21.5 mm/h), and comorbidity burden were higher in late-onset RA compared to young-onset RA (p < 0.01). Mean DAS28-ESR (4.6 vs. 4.3) and HAQ (1.2 vs. 1.1) scores were higher in late-onset RA patients (p < 0.05). Late-onset RA patients received more initial disease-modifying antirheumatic drug (DMARD) monotherapy and corticosteroids in comparison to greater DMARD/biologic combination therapy in young-onset RA patients (p < 0.05). Adjusted multivariate analyses showed that late-onset RA was independently associated with higher mean DAS28-ESR and HAQ scores, but not CDAI. Late-onset RA patients have greater disease activity that may contribute to disability early in the disease course. Despite this, initial treatment consists of less combination DMARD and biologic use in late-onset RA patients. This may have implications for future response to therapy and development of joint damage, disability, and comorbidities in this group.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

The influence of age at disease onset on disease activity and disability: results from the Ontario Best Practices Research Initiative

et al. 2015

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“…This may be dependent on the local setting as according to others, the use of DMARDs is comparable in both young and old RA patients [23,24]. The classic DMARD use varies from 12 to 97.3 % and decreases with age [37].…”

Section: Treatment Of Elderly Ra In the XXI Centurymentioning

confidence: 92%

“…In addition, female gender, high baseline disease activity, elderly onset, multiple comorbidities [21], especially cardiovascular disease, are also associated with disability and lower quality of life [24]. Impaired kidney and liver function and polypharmacy may also contribute to worse prognosis in the seniors with RA.…”

Section: Rheumatoid Arthritis In the Elderlymentioning

confidence: 99%

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Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Ishchenko

Lories

2016

Drugs Aging

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The population of elderly individuals with rheumatoid arthritis is rapidly expanding, mainly due to the increased life expectancy. While targeted biological therapies are well established for the treatment of this disease, their use may be lower in elderly (> of 65 years old) and very elderly patients (> 75 years old) due to perceived higher risks for adverse events in this population taking into account comorbidity, polypharmacy and frailty. In this review we discuss available evidence for the use of biological therapies in this growing patient group with specific attention towards eventual reasons for biological treatment failure or withdrawal. The majority of data is found in secondary analyses of clinical trials and in retrospective cohorts. Most information is available about tumor necrosis factor (TNF) blockers. Older patients seem to have a less robust response to anti-TNF agents than a younger population, but drug survival that may considered a proxy for efficacy does not seem to be influenced by age. Despite an overall rate of adverse effects comparable to that in younger patients, elderly RA patients are at higher risk of serious infections. Other biologics appear to have an efficacy similar to anti-TNF agents, also in the elderly RA patients. Again, the drug survival rates for tocilizumab, rituximab and abatacept resemble those in young RA patients with good general tolerability and safety profiles. The cardiovascular risk and the risk of cancer, increased in RA patents and in the elderly patients, do not appear to be strongly influenced by biologicals. Key points-Biological drugs targeting specific cytokines or immune cell populations are an important part of the management strategy for rheumatoid arthritis patients, including the elderly. 3-Overall safety and tolerability in the elderly patients is very good and age should not be a critical factor to decide against biological drug use.-The drug survival rate of biologicals in the elderly RA patients is comparable to that in the young RA population.-Co-morbidities and risk of infection are important variables to assess when considering a biological drug in the elderly.-More data and specific studies are required to better position biological drug use in this particular population as current studies provide a low level of evidence. Data in patients above 75 years are still largely missing. Moreover, the group of elderly patients that were included in clinical trials may be influenced by selection bias at inclusion and not be fully representative for infections risks and other comorbidities.4

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Comparison of Biologic Discontinuation in Patients With Elderly‐Onset Versus Younger‐Onset Rheumatoid Arthritis

Richter

Matteson

Davis

et al. 2019

ACR Open Rheumatology

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ObjectiveThe objective of this study is to compare biologic drug discontinuation rates for older‐ versus younger‐onset rheumatoid arthritis (YORA) because this is a key outcome measure that could impact prescribing practices.MethodsWe performed a retrospective medical record review of all patients who fulfilled the 1987 American College of Rheumatology (ACR) criteria for adult‐onset rheumatoid arthritis (RA) in 1999‐2013 among residents of a geographically defined area, with follow‐up until death, migration, or July 1, 2017. Discontinuation rates were estimated using cumulative incidence adjusted for the competing risk of death.ResultsA total of 240 cases of elderly‐onset rheumatoid arthritis (EORA) and 366 cases of YORA were identified (65% and 73% female, respectively; P = 0.025). Cumulative incidence of biologic initiation was lower among the EORA cohort compared with the YORA cohort (18% vs 33%, respectively, at 10 years after RA incidence; P < 0.001). Among those treated with a biologic, years from RA diagnosis to first biologic treatment was not significantly different between the two groups (P = 0.62). Drug survival of first biologic was 64% at 1 year (95% confidence interval [CI]: 45%‐77%) and 53% at 2 years (95% CI: 33%‐66%) for EORA, compared with 61% at 1 year (95% CI: 50%‐69%) and 45% at 2 years (95% CI: 34%‐53%) for YORA (P = 0.75). Concurrent glucocorticoid use at initiation of first biologic was statistically and significantly associated with a lower risk of discontinuation in EORA (hazard ratio 0.21; 95% CI: 0.08‐0.53) but not in YORA (interaction P = 0.04).ConclusionDrug survival rates of biologic medications did not differ significantly between patients with EORA and YORA.

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Do Patients with Elderly-Onset Rheumatoid Arthritis Have Severe Functional Disability?

Cited by 45 publications

References 18 publications

The influence of age at disease onset on disease activity and disability: results from the Ontario Best Practices Research Initiative

The influence of age at disease onset on disease activity and disability: results from the Ontario Best Practices Research Initiative

Safety and Efficacy of Biological Disease-Modifying Antirheumatic Drugs in Older Rheumatoid Arthritis Patients: Staying the Distance

Comparison of Biologic Discontinuation in Patients With Elderly‐Onset Versus Younger‐Onset Rheumatoid Arthritis

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